Azithromycin should be used during pregnancy and lactation only if clearly needed.
If an allergic reaction occurs, the drug should be discontinued and contact a physician.
As with Erythromycin and other macrolides, rare serious side effects including angioedema and anaphylaxis, have been reported.
No dose adjustment is needed in patients with mild renal impairment (creatinine clearance > 40 mL/min), but there is no data regarding Azithromycin usage in patients with more severe renal impairment, thus Azithromycin should be used with caution in these patients.
As the liver is the principal route of excretion of Azithromycin, it should not be used in patients with hepatic disease.
As with any antibiotic, observation for signs of superinfection with non-susceptible organisms, including fungi, is recommended.
Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for outpatient oral therapy because of moderate to severe illness or risk factors such as any of the following: Nosocomially acquired infections, known or suspected bacteremia, elderly or debilitated patients, conditions requiring hospitalization, significant health problems (including immunodeficiency or functional asplenia).